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Coverage for Physiotherapy Services

On August 1, 2013 changes are coming to how physiotherapy is funded in Ontario. Learn more >>

The information below pertains to physiotherapy services delivered in non-hospital settings by Designated Physiotherapy Clinics (DPCs). Publicly funded physiotherapy services may also be provided in hospitals on an inpatient or outpatient basis, by Community Care Access Centres for patients eligible for home care and in other settings.

The Workplace Safety Insurance Board (WSIB) may also cover physiotherapy services for workers.

Ontarians with private insurance should check to see if their plan has coverage for physiotherapy.

Non-hospital physiotherapy services provided by DPCs are covered by OHIP for insured persons who have a physician referral and are:

aged 65 and older;
aged 19 and younger;
any age and a Long-Term Care Home (LTCH) resident¹ ; or
any age and need physiotherapy services in their home (if required to be provided in their home due to their medical condition, illness or injury), or after being hospitalized overnight as an inpatient.

Physiotherapy services provided in a clinic or in a person’s home (excluding LTCHs) may be eligible for OHIP coverage only if the services are provided in or by a DPC. In LTCHs, providers other than DPCs may provide insured physiotherapy services.

Clients on social assistance in Ontario, (e.g., the Ontario Works Program (OW) or the Ontario Disability Support Program (ODSP)) who are between the ages of 19 and 64 and who do not otherwise meet the above criteria for insured services are still eligible for publicly funded physiotherapy services provided by DPCs. The ministry’s policy is that the funding and delivery of these uninsured services should be the same as for insured services. Therefore, (if DPCs bill OHIP for these services provided to social assistance clients) it is the ministry’s policy that clients not be charged any additional amount over what OHIP pays the provider for the service. However, DPCs may continue to charge clients for assessment and re-assessment fees.

^{1. In LTCHs, residents may access insured physiotherapy services not only through a physician referral but also if ordered by the nurse who is most responsible for the resident’s nursing care.}

Frequently Asked Questions

How much does OHIP pay for these services?

OHIP pays $12.20 for all insured physiotherapy services with the exception of the initial physiotherapy visit in a person’s home or LTCH which pays $24.40.

DPCs may charge patients assessment fees and reassessment fees. This charge is not covered by OHIP. Individuals should speak with their physiotherapist or the College of Physiotherapists of Ontario regarding these fees.

Will my employer or my insurance company pay for the whole cost of these services?

This depends on your policy. Individuals should speak with their employers or insurers about coverage under their plan.

How many physiotherapy visits are insured?

A maximum of 50 visits are insured by OHIP for patients requiring physiotherapy after they are discharged from hospital as an inpatient.

In all other cases, eligible individuals are covered for up to100 visits a year. However, in exceptional circumstances, (and where the physiotherapist specifies the description and additional number of treatments required in order to discharge the patient) up to an additional 50 services a year may be covered.

The ministry requires a written referral from a physician or, for LTCH residents, from the nurse most responsible for the resident’s care, for these OHIP funded physiotherapy services.

Are physiotherapy services for an insured resident of an LTCH who is not a senior insured?

All insured LTCH residents are eligible as long as the physiotherapy services are ordered by a physician or the nurse in the LTCH who is most responsible for the resident’s nursing care.

Are physiotherapy services covered for inpatients at hospitals?

Yes, if the services are available, physiotherapy services are covered for a hospital in-patient during their admission.

Am I covered after having elective surgery for which I was an inpatient?

Insured individuals discharged after an overnight stay as a hospital inpatient may be covered for services provided by or at a DPC as long as they have a referral from a hospital physician. These individuals may also be eligible for out-patient physiotherapy services if they are available at the hospital (not all hospitals offer out-patient physiotherapy services).

What about the insured person who has a sports injury, is not hospitalized and requires physiotherapy?

These people will not be eligible for OHIP insured physiotherapy unless it is ordered by a physician and the person is 65 and older, younger than 20, or any age if physiotherapy is required in-home because of the person’s condition, illness or injury.

These Ontarians may have private insurance coverage for physiotherapy or may have to pay for it themselves.

What about the person who was taken to the Emergency Department with an injury but was not admitted to hospital?

These people will not be eligible for OHIP insured physiotherapy unless they have a physician referral and are 65 and older, younger than 20, or any age if physiotherapy is required in-home because of their condition, illness or injury.

These Ontarians may have private insurance coverage for physiotherapy or may have to pay for it themselves.

If I'm between 20 and 64 years of age and need physiotherapy in my home because of my condition, am I eligible for coverage under OHIP?

Yes. You must have a condition, illness or injury that requires you to receive physiotherapy in your home and you must have a referral from your physician. If you live in an LTCH, you are also eligible if you have a written referral from your physician or the nurse most responsible for your nursing care and you require physiotherapy in the home because of your condition, illness or injury.

What about physiotherapy services for clients on social assistance, for example, OW or ODSP?

Clients on social assistance in Ontario, who are between the ages of 19 and 64 and who do not otherwise meet the above criteria for insured services are still eligible for publicly funded physiotherapy services provided by DPCs. The ministry’s policy is that the funding and delivery of these uninsured services should be the same as for insured services. Therefore, (if DPCs bill OHIP for these services provided to social assistance clients) it is the ministry’s policy that clients not be charged any additional amount over what OHIP pays the provider for the service. However, DPCs may continue to charge clients for assessment and re-assessment fees.

Clients should speak with their physiotherapist or the College of Physiotherapists of Ontario regarding these fees.

What is a DPC and how can I find one?

A DPC is a physiotherapy clinic that has been prescribed by law as a health facility entitled to payment for providing insured physiotherapy services. You can see a list of DPCs by clicking here: Designated Physiotherapy Clinics.

Note: The information provided in this document is a general summary provided for information purposes only. The Health Insurance Act and its respective regulations outline all conditions of OHIP coverage. Ontario laws and regulations are available on-line at www.e-laws.gov.on.ca

May 2013 Reference Number Catalogue #: 018059